Life Expectancy After Surgical Aortic Valve Replacement

BACKGROUND Surgical risk, age, perceived life expectancy, and valve durability influence the choice between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation. The contemporaneous life expectancy after SAVR, in relation to surgical risk and age, is unknown. OBJECTIVES The purpose of this study was to determine median survival time in relation to surgical risk and chronological age in SAVR patients. METHODS Patients >= 60 years with aortic stenosis who underwent isolated SAVR with a bioprosthesis (n = 8,353) were risk-stratified before surgery into low, intermediate, or high surgical risk using the logistic EuroSCORE (2001-2011) or EuroSCORE II (2012-2017) and divided into age groups. Median survival time and cumulative 5-year mortality were estimated with Kaplan-Meier curves. Cox regression analysis was used to further determine the importance of age. RESULTS There were 7,123 (85.1%) low-risk patients, 942 (11.3%) intermediate-risk patients, and 288 (3.5%) high-risk patients. Median survival time was 10.9 years (95% confidence interval: 10.6-11.2 years) in tow-risk, 7.3 years (7.0-7.9 years) in intermediate-risk, and 5.8 years (5.4-6.5 years) in high-risk patients. The 5-year cumulative mortality was 16.5% (15.5%-17.4%), 30.7% (27.5%-33.7%), and 43.0% (36.8%-48.7%), respectively. In low-risk patients, median survival time ranged from 16.2 years in patients aged 60 to 64 years to 6.1 years in patients aged >= 85 years. Age was associated with 5-year mortality only in low-risk patients (interaction P < 0.001). CONCLUSIONS Eighty-five percent of SAVR patients receiving bioprostheses have tow surgical risk. Estimated survival is substantial following SAVR, especially in younger, tow-risk patients, which should be considered in Heart Team discussions. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Automated summary

Surgical risk, age, and perceived life expectancy influence the choice between SAVR and transcatheter aortic valve implantation. This study aimed to determine median survival time in relation to surgical risk and chronological age in SAVR patients. The estimated survival is substantial following SAVR, especially in younger, low-risk patients.